hyperthyroid or hypo

[123brina]

Female age 27
Free T4 is hight 31.29
TSH low <0.05
Microsomal TPO-Ab high 310
Thyroglobulin Antibodies normal <20
Ultrasound shows slight heterogenous appearance to thyroid gland mild increase vascular flow, no nodule
I was told I have Hyperthyroid but the Microsomal indicated Hypo.    poss. Hashimotos
My Dr. wants me to have surgery or radiation. Hyperthyroid meds are helping to regulate levels
Two years ago all levels were normal
Do I have hyperthyroid, do I need surgery?

[Barb135]

I think you should get the TSI test, which is the definitive test for Graves.  

It's not unusual for persons with Hashi's to have episodes of being hyper.  

You should ask your doctor to test FT3, along with the FT4 and TSH.

[Red_Star]

Based on your current lab work, Graves Disease is likely.

Lab Tests Online - Graves Disease:

"TSH — typically low in Graves disease
Total or free T4 — usually elevated
Total or free T3 — often elevated

Laboratory tests used to help diagnose Graves disease and distinguish it from other autoimmune conditions may include one or more tests used to detect the presence of thyroid antibodies:

Thyroid stimulating immunoglobulin (TSI) — The presence of this antibody is diagnostic for Graves disease.

Thyroid stimulating hormone receptor antibody (TRAb) — less specific than TSI

Anti-thyroid peroxidase antibody (anti-TPO) — This autoantibody is found in most people with Graves disease as well as in Hashimoto thyroiditis.

Non-laboratory Tests

Radioactive iodine uptake — For this test, a capsule or "cocktail" containing a measured amount of radioactive iodine is swallowed; iodine is a critical component of thyroid hormones. The iodine accumulates in the thyroid; more accumulates when the gland is overactive, as occurs in Graves disease. After a specified amount of time, a probe similar to a Geiger counter is placed over the thyroid and the amount of radioactivity is compared to the amount that was given."

As for your ultrasound, i found the following:

"It has been reported that among 55 patients with hyperthyroidism (29 Graves' disease and 26 toxic nodules), color flow Doppler examination was useful to differentiate the etiology. Increased blood flow was successful in differentiating untreated Graves' disease from the Hashimoto’s thyroiditis, which had similar gray scale findings, (p < 0.001) and controls (p < 0.001)."
- excerpt from the article: Chapter 6c – Ultrasonography of the Thyroid by Manfred ****, M.D.

There are natural products and dietary changes to help with hyperthyroidism and Graves symptoms. A video on youtube called "8 Herbs For Hyperthyroidism & Graves' Disease" is worth watching.  You may want to try a combination of natural and prescription anti thyroid medication.

Radioactive iodine is seen as the cheapest and quickest method of "curing" hyperthyroidism. The downside is a high risk of developing permanent hypothyroidism.

A thyroidectomy (thyroid removal) is not the most commonly used method to treat hyperthyroidism but it may be appropriate if you are allergic to antithyroid medications, resistant to radioactive iodine, your thyroid gland is very large, nodules that may cancerous, or with significant eye changes (ophthalmopathy).